Friday, 9 September 2011

How many applicants are you competing with for that one spot?



Demand and supply: Analysis of the positions available for international medical graduates based on specialty specific residency spots.

Mleresidencytips Droidor, MD PhD. © 2011

Abstract: Analysis of the NRMP database to ascertain the applicant to position ratio (A/p). Novel algorithm was applied and the result expressed in a color-coded heat map and a dendrogram. I find that the applicant to position ratio for specialties underestimates the demand for the positions especially when it concerns IMGs. Detailed analysis of IMG friendly programs is made in conjunction with the (A/p) ratio.

Introduction:

Each year there are hundreds of IMGs who will apply for residency. The demand for residency spots is exponential and has shown a tremendous increase in the recent years, with thousands of IMGs and American applicants applying than the preceding years. This article aims to analyze the number of openings that are available for IMGs in the field of their choice. The data was obtained from the national resident matching program database publication, "charting outcomes for the match (2011)." Even though NRMP, provides the number of applicants per position information, this data is not specific to the international medical graduate. The following article provides information which will help an IMG to decide what field they should be applying to.

Results:

After looking at the data from the national resident matching program1, I came up with a formula that would lead me calculate positions that are open for IMGs and how many IMGs apply one position in a particular specialty. This formula, is depicted in figure 1 and takes into account the total IMGs that apply, the total positions that are offered, and the number of US applicants who match that specialty. This algorithm was used on all the specialties and the adjusted IMG applicant/position ratio is depicted in figure 1.


Figure 1: Algorithm and A/p ratio heat map

Each value is color-coded red. Red denotes more applicants for the position and green denotes fewer applicants per position. The cutoff for the watershed for the color coding was a value of 1.5. What was surprising, is that the unadjusted value reported by NRMP is nowhere close to the value adjusted for IMGs. For example, you can see that for psychiatry while NRMP says that there are 1.5 applicants were position in reality there are two IMGs for every single position that apply to the program. Thus, the unadjusted a/p ratio tends to underestimate the demand of residency spots.

Next, I placed the programs in the descending order of their ratios and made a heat map of the values. This is depicted in figure 2, where you can see that the most red values are at the top and the most green values [favorable] at the bottom.



Interestingly enough, ENT (OTO) at the 3.44 applicants per position followed by orthopedics at the 3.41, then neurosurgery, general surgery, dermatology, psychiatry [2.01], internal medicine at [1.93], obstetrics and gynecology, radiation oncology and emergency medicine [1.71]. Those specialties with comparatively fewer applicants per position are family medicine [1.56], followed by neurology [1.55], pediatrics [1.36] and lastly plastic surgery [0.85]. This heat map only places. These positions in the descending order of availability without regard for whether that IMG friendly or not.

Figure 3: Dendrogram of A/p values in relation to IMG friendly specialties.

To address this issue, I arranged the programs based on the dendrogram into three clusters. This is depicted in figure 3. The clusters were based on the previous result that was published in an earlier article on this website2. That figure is depicted to the left of the dendrogram. The first cluster was IMG friendly programs and called as "IMG primary cluster". This group included psychiatry, internal medicine, family medicine and pediatrics. The second group was the "IMG secondary cluster" and included those nationalities that are not heavily pursued by IMGs including general surgery, obstetrics and gynecology, emergency medicine, pathology, anesthesia and neurology. The third clusters. I called it as the "non-IMG cluster", because this group at the least international graduates applying the specialties. As you can see from the cladogram that in the primary cluster psychiatry is the one most in demand with 2.01 international applicants per position, followed by internal medicine, family practice and pediatrics [1.36]. In the secondary cluster general surgery seem to be the toughest to get into with 2.59 applicants for one position followed by obstetrics, emergency medicine, pathology, anesthesia and neurology [1.55]. The non-IMG cluster was the toughest group to be broken into because they're very anywhere from 2 to 3 applicants for spot. The reason physical medicine and rehabilitation and plastic surgery and green is because the numbers were too low and the sample size rockabilly skewed the value towards more favorable than not.

Discussion:

The basis of the study is the formula depicted in figure 1. It assumes exclusion of seats to IMG by subtracting the US applicants that matched to the specialties. This does not take into account other factors that may affect residency. Total IMGs are combined value of both matched and unmatched groups and was considered this way to see how many IMGs apply.

Conclusion:

This analysis provides an interesting insight into the demand and supply game for residency spots. The number of applicants for one spot is higher for international graduates than all the applicants put together. The results of the study are helpful in determining what would be a good backup specialty to apply to. For example, if your application is geared towards internal medicine, have minimal psychiatry experience then it would be safer to use pediatrics as a backup just because there are fewer competing applicants rather than psychiatry where there are more.

References:
  1. NRMP charting outcomes from match, 2011



Demand and supply: Analysis of the positions available for international medical graduates based on specialty specific residency spots. -

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